• José M Porcel, Carlos Galindo, Aureli Esquerda, Javier Trujillano, Agustín Ruiz-González, Miquel Falguera, and Manuel Vives.
• Pleural Diseases Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital, IRBLLEIDA, Lleida, Spain. jporcelp@yahoo.es
• Respirology. 2008 Jan 1; 13 (1): 58-62.

Background And ObjectiveThis study was designed to test the hypothesis that measurement of IL-8 and CRP in pleural fluid could improve the identification of patients with non-purulent parapneumonic effusions that ultimately require chest tube drainage.MethodsWe assessed IL-8, CRP and three classical parameters (pH, glucose and LDH) in the pleural fluid of 100 patients with parapneumonic effusions. Forty-nine of these patients had non-purulent complicated effusions (complicated parapneumonic pleural effusion, CPPE), and 51 had uncomplicated parapneumonic pleural effusions (UPPE). Receiver-operating characteristic curves were used to assess the sensitivity and specificity of pleural fluid biochemical parameters for differentiating among the two patient groups. IL-8 production was determined using a commercially available ELISA kit, and CRP was measured by immunoassay.ResultsAt a cutoff value of 1000 pg/mL, IL-8 differentiated CPPE from UPPE with a sensitivity of 84% and a specificity of 82%. Likewise, CRP levels were higher in CPPE than in UPPE, and showed 72% sensitivity and 71% specificity at a cutoff value of 80 mg/L. We found that all five pleural fluid tests showed similar diagnostic accuracies when evaluated by receiver-operating characteristic analysis. However, multivariate analysis indicated that the size of the effusion, as well as pleural fluid pH and IL-8 concentration, were the best discriminatory parameters, with likelihood ratios of 6.4, 4.4 and 3.9, respectively.ConclusionsPleural fluid IL-8 is an accurate marker for the identification of non-purulent CPPE.

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